This is the first of a three-part series based on the book You Are Not Your Pain: Using Mindfulness to Relieve Pain, Reduce Stress and Restore Well-Being. This feature explains the pain experience and how the mind and body can work together to bring relief. Future installments will detail the techniques used in the eight-week integrative program.

You Are Not Your Pain, by Danny Penman and Vidyamala Burch, was written after both authors survived their own chronic pain experiences. To learn more about their pain journeys and their book, visit velaharbor.com, www.breathworks-mindfulness.org.uk or www.franticworld.com. The book includes a CD that guides listeners through an eight-week series of mindful meditation.

WHAT YOU RESIST PERSISTS: FROM ROPE & GATE THEORY TO MINDFUL AWARENESS

The 17-century French philosopher René Descartes first formalized a pain theory called the “rope-pull” model of pain. Like pulling a rope rings a church bell, Descartes thought that damage to the bod   y is a tug that causes the awareness of pain in the brain. For centuries after Descartes, the intensity of pain was thought to be directly proportional to the degree of damage to the body, which would mean that if different people had the same injury, they would experience the same amount of pain. If no obvious physical cause were found, the patient would be regarded as malingering or making it up.

Since the 1960s, scientists have come to accept an-other model of pain known as the Gate Theory. They suggest that there are gates in the brain and nervous system that, when open, allow you to experience pain. In a sense, the body sends a continuous low-level chatter of pain signals to the brain, but only when the gates are opened do the signals reach your conscious mind. These gates can also close, which is what happens when your pain lessens or fades away.

Opening and closing these pain gates is a phenomenally complex process. While so much of the pain experience continues to be a mystery, we’re learning more about how pain can be reduced. Pain is a sensation, which means that it is an interpretation made by the brain before it is consciously felt. To make this interpretation, the brain fuses together information from the mind as well as the body. This means that the thoughts and emotions flowing through your mind, both conscious and unconscious, have a dramatic effect on the intensity of your suffering.

THE MANY FACES OF PAIN

Acute pain occurs in the short term and is usually a direct response to an injury. It’s part of the body’s built-in alarm system, signaling that it’s under attack and that you should take care of the injured area. Most healing is completed within six weeks, and acute pain usually reduces over this period. Chronic pain lasts for three months or more and sometimes develops after an injury, or in connection with arthritis or cancer; it may also start for no obvious or specific reason. If the pain remains when there’s no continuing physical damage, it is often known as chronic pain syndrome.

Neuropathic pain occurs in the nervous system and might result from damage to the nerves, spinal cord or brain. But sometimes pain is felt even when there is no damage, or when healing seems to have completed. One possibility is that background noise in the nervous system becomes unduly amplified. This is believed to happen because the nervous system responds to the experience of pain by increasing its capacity to process pain signals—as a computer de-votes extra memory and circuits to an important task. Neuropathic pain can also take the form of unusual sensations, such as burning or electric shocks and can even occur in amputated limbs. Some forms of tinnitus (ringing or white-noise sounds in the ears) can be considered neuropathic pain.

yanypPRIMARY AND SECONDARY SUFFERING

Suffering occurs on two levels. First, there are the actual unpleasant sensations felt in the body—this is known as primary suffering. This can be seen as the raw data that is sent to the brain from, say, an injury, an ongoing illness, or changes to the nervous system itself. Overlaid on this is secondary suffering, which is made up of all the thoughts, feelings, emotions and memories associated with the pain. These might include anxiety, stress, worry, depression and feelings of hopelessness and exhaustion. The pain and distress that you actually feel is a fusion of both primary and secondary suffering.

This insight is crucial because it reveals a path away from suffering. If you can learn to tease apart the two flavors of suffering, you can greatly reduce—or even eliminate—your pain and distress. This is because secondary suffering tends to dissolve when you observe it with the mind’s compassionate eye. Mindfulness lets you see the different elements of pain laid out in front of you. When you see this vista, something remarkable will happen: your suffering gradually begins to subside.

It’s important to understand that although the sensation of pain is created by the mind, your suffering is still real. You do feel it. It exists, and it can be genuinely overwhelming. But once you understand the underlying mechanisms of pain, you can begin to temper its power and the hold it has over you.

PAIN AND SUFFERING

Anxiety, fear, anger, worry and depression can feed into the mind’s perception of pain. Feeling tired and overwhelmed, fragile and broken, stressed and anxious can all magnify suffering and tip you into a downward spiral. These emotions act like amplifiers in the mind’s pain circuits. They can open the floodgates of suffering.

The effect of such emotions can be observed with a brain scanner. Work at Oxford University, for example, shows the significant impact that even mild levels of anxiety can have on pain. Scientists at the university’s Department of Clinical Neurology induced low-level anxiety in a group of volunteers before burning the backs of their left hands with a hot probe. As anxiety built, you could see the waves of emotion sweeping through the volunteers’ brains. When the skin of the anxious volunteers was actually burned, they experienced far more pain and suffering than the non-anxious volunteers. Anxiety and other powerful negative emotions had primed the body and prepared it to sense pain quickly and with great intensity.

The reverse is also true. Reducing anxiety, stress, depression and exhaustion can lower the perception of pain and even eliminate it. This is one of the main routes by which mindfulness helps reduce suffering. Mindfulness soothes the mind’s perception of pain—essentially secondary suffering—by replacing it with a sense of peace and wholeness.

Neuroscientist Fadel Zeidan and his team at Wake Forest University School of Medicine decided to investigate this effect using scanners to map activity in different parts of the brain. They did this by exploiting a curious quirk of brain anatomy. Every part of the body is reflected in a specific part of the brain known as the primary somato sensory cortex. So if the sole of your left foot is brushed with a feather, an area of the primary somato sensory cortex lights up; if you feel a pain in your lower back, a different part becomes active. Neurosurgeon Wilder Penfield charted this brain region and produced a map that reflects the human body overlaid on the brain. It was termed the cortical homunculus.

Fadel Zeidan and his team reasoned that if mindfulness affected the perception of pain, then this should be visibly reflected in the level of activity in the corresponding regions of the primary somato sensory cortex. To test this, Zeidan studied the perception of pain in a group of students. The students first had the back of their right calf burned with a piece of hot metal while their brain was scanned with the latest functional magnetic resonance imaging (fMRI) scanner. Each was then asked to rate both the intensity and the unpleasantness of the pain. If pain were music, “intensity” would be the volume and “unpleasantness” would be the level of emotion it aroused. As expected, when the students’ legs were burned, the “right calf” region of their primary somato sensory cortex lit up as the pain swept over them.

The students were then taught mindfulness meditation and the experiment was repeated. The results could not have been more different the second time around. Activity in the right-calf region of the primary somato sensory cortex had diminished to such a degree that it had become undetectable. But not only that. Meditation increased activity in regions of the brain related to the processing of emotion and of cognitive control—areas where the sensations of pain are actually interpreted and “built.” These brain areas modulate the sensations of pain and give it meaning before it is consciously felt. What’s more, experienced meditators (those who scored higher on a standard scale of mindfulness) tended to have enhanced activity in these regions and to experience less pain. That is, they tended to devote more brain power in this region to moderating the pain-related information—and to, in effect, turning down its volume.

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And what of the students’ conscious experience of pain? On average they experienced a 40 percent reduction in pain intensity and a 57 percent lessening of pain unpleasantness. Perhaps the most surprising thing was the amount of practice required to achieve this level of pain relief: just four training sessions of twenty minutes each.

Remarkable though these results were, they masked something even more intriguing. The more accomplished meditators suffered far less than these averages might suggest. They encountered a reduction in pain intensity of 70 percent and in unpleasantness of 93 percent. This meant that the pain could barely be felt and hardly bothered them. Overall, says Zeidan, mindfulness produced a greater reduction in pain than standard doses of morphine and other pain-relieving drugs.

yanyp3LOOSENING THE BONDS OF PAIN

Secondary suffering can be seen as resistance to pain. It is entirely natural to struggle against and resist pain with all your might. But what if, in your bid to eliminate pain, you were actually creating far more of it instead? This is the lesson from Zeidan’s research and from many other studies, too. This holds true not just for pain, but for many other disease symptoms. Stress, exhaustion and depression can all be made far worse through resistance.

But if resisting pain can make it worse, the converse is also true. Acceptance of your pain can actually diminish it—and might even get rid of it completely. Allow us to explain this seemingly outrageous idea.

Neuroscientists have a saying: “What we resist persists.” In other words, if you resist the messages that your mind and body are sending you, those messages will keep on being dispatched (and felt) until you accept them. This holds true not only for messages of pain, but also for thoughts, feelings, emotions, memories and judgments. If you mindfully accept (or feel) these messages, they will have done their job and will tend to melt away.

Mindfulness meditation creates a sense of safety, of space, in which you can begin to explore the raw sensations of pain, and thus it is the vehicle through which you can begin to accept these messages. When you do so, you will often find that pain waxes and wanes quite dramatically. Long moments of normality can be followed by flickers or spikes of pain. There are often different sensations, too. Some are hot. Others cold. Some feel “tight,” others throb, while still others feel sharp or stabbing. Not all are completely unpleasant. The different sensations often rise and fall like the waves on the sea. They constantly change in character and intensity. By exploring each of these different sensations, moment by moment, you come to accept that they are like black clouds in the sky: you can watch as the sensations arise, drift past and disappear again. Your mind is like the sky, and individual thoughts, feelings, emotions and sensations are like different types of clouds. So in a sense, mindfulness teaches you to observe the weather without becoming embroiled in it. No matter what happens, the sky—your mind—remains untouched by it.

It is important to realize that mindful acceptance is not resignation to your fate. It is not the acceptance of the unacceptable. It is simply the acceptance of the situation as it is, for now at least. It is a period of allowing, of letting be, of nonresistance, so that you cease to struggle. When this struggle ceases, a sense of peace takes its place. Secondary suffering then progressively diminishes. Often as not, primary suffering will begin to do so, too.

We can explain more detail and cite numerous scientific trials about how your brain “builds” the sensations of pain from your thoughts, feelings, and emotions—but practicing mindfulness is truly the only way to understand and believe it.

Accepting pain can be difficult. It’s just better than the alternative, which is to live in perpetual suffering.

Accepting the sensations of primary suffering allows the secondary suffering to take care of itself—and to progressively diminish.

CLAIRE’S STORY OF DESPERATION: HOW MINDFULNESS, THE LAST RESORT, WORKED

Claire had chronic pain. She discovered that she could resist pain for days or even weeks. She could distract herself with alcohol, cigarettes and food. She could squash the pain with powerful drugs. If those failed, she could ignore the pain—for a while, at least. But all this came at a cost: the rest of her life. She discovered that in ignoring and walling off the pain she had also isolated herself from life’s joys. Food lost its flavor. She no longer laughed or cried. Her love life declined. Not only did the pain return, but she was left feeling fragile and broken. She became her pain. No wonder her doctor wanted to prescribe her antidepressants.

After three years of struggling, Claire embraced mindfulness—not be-cause she believed that it would work, but because she was desperate. When she began to mindfully explore the sensations of pain, something remarkable and counterintuitive began to happen. Not only did the pain begin to subside, but she began to experience happiness, love, compassion and empathy. Sadness remained, but when she let go of expecting life to be either wholly wonderful or truly distressing but experienced it as a delicate mixture of the two, she felt increasingly relaxed and open. Becoming aware brought balance. She could finally begin to heal. {PP}